<form id="AddressFormInline-Form" name="AddressFormInline-Form" autocomplete="on" method="post">
  <div class="addressFormInline-wrap">
    <input type="hidden" name="addressType" value="S">

    <p style="margin-bottom: 6px;" id="addressFormInlineRequired" tabindex="-1"><span class="asterisk">*</span> Required fields</p>

    <div id="personName" style="overflow: auto;">
      <div style="float: left; margin-right: 13px; width: 150px">
        <label for="addressFormInlineFirstName">FIRST NAME<span class="asterisk">*</span></label>
        <div style="margin-top: 6px;">
          <input id="addressFormInlineFirstName" name="addressFormInlineFirstName" type="text" maxlength="40" style="width: 140px;">
        </div>
      </div>
      <div style="float: left; margin-right: 15px">
        <label for="addressFormInlineMiddleInitial">M.I.</label>
        <div style="margin-top: 6px;">
          <input id="addressFormInlineMiddleInitial" name="addressFormInlineMiddleInitial"type="text" class="miField" maxlength="1" style="width: 26px;">
        </div>
      </div>
      <div style="float: left; width: 150px">
        <label for="addressFormInlineLastName">LAST NAME<span class="asterisk">*</span></label>
        <div style="margin-top: 6px;">
          <input id="addressFormInlineLastName" name="addressFormInlineLastName" type="text" maxlength="40" style="width: 150px;">
        </div>
      </div>
    </div>

    <div id="city" style="margin-top: 15px;">
      <label for="addressFormInlineCompany">COMPANY NAME</label>
      <div style="margin-top: 6px;">
        <input id="addressFormInlineCompany" name="addressFormInlineCompany" type="text" maxlength="40" style="width: 265px">
      </div>
    </div>

    <div style="display: inline-block; margin-top: 15px;">
      <label for="addressFormInlineCountry">COUNTRY<span class="asterisk">*</span></label>
      <div style="margin-top: 6px;">
        <select id="addressFormInlineCountry" class="country_select" name="addressFormInlineCountry" style="width: 277px;"><option value="US">United States</option></select>
      </div>
    </div>

    <div id="streetAddress" style="margin-top: 15px;">
      <legend><label for="addressFormInlineAddressLine1">STREET ADDRESS<span class="asterisk">*</span></label></legend>
      <div style="margin: 6px 0 6px">
        <input id="addressFormInlineAddressLine1" name="addressFormInlineAddressLine1" placeholder="Address Line 1" type="text" maxlength="30" style="width: 265px;">
      </div>
        <input id="addressFormInlineAddressLine2" name="addressFormInlineAddressLine2" placeholder="Address Line 2" type="text" maxlength="30" style="width: 265px;">
    </div>

    <div id="city" style="margin-top: 15px;">
      <label for="addressFormInlineCity">CITY<span class="asterisk">*</span></label>
      <div style="margin-top: 6px;">
        <input id="addressFormInlineCity" name="addressFormInlineCity" type="text" maxlength="40" style="width: 265px">
      </div>
    </div>

    <div id="state" style="overflow: auto; margin-top: 15px;">
      <div style="float: left; margin-right: 15px;">
        <label for="addressFormInlineState">STATE / PROVINCE<span class="asterisk">*</span></label>
        <div style="margin-top: 6px; width: 150px;">
          <select addresstype="S" id="addressFormInlineState" name="addressFormInlineState" class="state_select"><option value="NO_STATE_TYPE_SELECTED" selected="selected" class="form-dropDownSelectionForceBlack">* Select</option><option value="Aa" class="form-dropDownSelectionForceBlack">AA - Armed Forces America</option><option value="Ae" class="form-dropDownSelectionForceBlack">AE - Armed Forces Europe</option><option value="AL" class="form-dropDownSelectionForceBlack">Alabama</option><option value="AK" class="form-dropDownSelectionForceBlack">Alaska</option><option value="Ap" class="form-dropDownSelectionForceBlack">AP - Armed Forces Pacific</option><option value="AZ" class="form-dropDownSelectionForceBlack">Arizona</option><option value="AR" class="form-dropDownSelectionForceBlack">Arkansas</option><option value="CA" class="form-dropDownSelectionForceBlack">California</option><option value="CO" class="form-dropDownSelectionForceBlack">Colorado</option><option value="CT" class="form-dropDownSelectionForceBlack">Connecticut</option><option value="DE" class="form-dropDownSelectionForceBlack">Delaware</option><option value="DC" class="form-dropDownSelectionForceBlack">District of Columbia</option><option value="FL" class="form-dropDownSelectionForceBlack">Florida</option><option value="GA" class="form-dropDownSelectionForceBlack">Georgia</option><option value="HI" class="form-dropDownSelectionForceBlack">Hawaii</option><option value="ID" class="form-dropDownSelectionForceBlack">Idaho</option><option value="IL" class="form-dropDownSelectionForceBlack">Illinois</option><option value="IN" class="form-dropDownSelectionForceBlack">Indiana</option><option value="IA" class="form-dropDownSelectionForceBlack">Iowa</option><option value="KS" class="form-dropDownSelectionForceBlack">Kansas</option><option value="KY" class="form-dropDownSelectionForceBlack">Kentucky</option><option value="LA" class="form-dropDownSelectionForceBlack">Louisiana</option><option value="ME" class="form-dropDownSelectionForceBlack">Maine</option><option value="MD" class="form-dropDownSelectionForceBlack">Maryland</option><option value="MA" class="form-dropDownSelectionForceBlack">Massachusetts</option><option value="MI" class="form-dropDownSelectionForceBlack">Michigan</option><option value="MN" class="form-dropDownSelectionForceBlack">Minnesota</option><option value="MS" class="form-dropDownSelectionForceBlack">Mississippi</option><option value="MO" class="form-dropDownSelectionForceBlack">Missouri</option><option value="MT" class="form-dropDownSelectionForceBlack">Montana</option><option value="NE" class="form-dropDownSelectionForceBlack">Nebraska</option><option value="NV" class="form-dropDownSelectionForceBlack">Nevada</option><option value="NH" class="form-dropDownSelectionForceBlack">New Hampshire</option><option value="NJ" class="form-dropDownSelectionForceBlack">New Jersey</option><option value="NM" class="form-dropDownSelectionForceBlack">New Mexico</option><option value="NY" class="form-dropDownSelectionForceBlack">New York</option><option value="NC" class="form-dropDownSelectionForceBlack">North Carolina</option><option value="ND" class="form-dropDownSelectionForceBlack">North Dakota</option><option value="OH" class="form-dropDownSelectionForceBlack">Ohio</option><option value="OK" class="form-dropDownSelectionForceBlack">Oklahoma</option><option value="OR" class="form-dropDownSelectionForceBlack">Oregon</option><option value="PA" class="form-dropDownSelectionForceBlack">Pennsylvania</option><option value="PR" class="form-dropDownSelectionForceBlack">Puerto Rico</option><option value="RI" class="form-dropDownSelectionForceBlack">Rhode Island</option><option value="SC" class="form-dropDownSelectionForceBlack">South Carolina</option><option value="SD" class="form-dropDownSelectionForceBlack">South Dakota</option><option value="TN" class="form-dropDownSelectionForceBlack">Tennessee</option><option value="TX" class="form-dropDownSelectionForceBlack">Texas</option><option value="UT" class="form-dropDownSelectionForceBlack">Utah</option><option value="VT" class="form-dropDownSelectionForceBlack">Vermont</option><option value="VA" class="form-dropDownSelectionForceBlack">Virginia</option><option value="WA" class="form-dropDownSelectionForceBlack">Washington</option><option value="WV" class="form-dropDownSelectionForceBlack">West Virginia</option><option value="WI" class="form-dropDownSelectionForceBlack">Wisconsin</option><option value="WY" class="form-dropDownSelectionForceBlack">Wyoming</option></select>
        </div>
      </div>
      <div style="float: left;">
        <label for="addressFormInlineZip">ZIP / POSTAL CODE<span class="asterisk">*</span></label>
        <div style="margin-top: 6px; width: 140px">
          <input id="addressFormInlineZip" name="addressFormInlineZip" class="zipField" type="text" maxlength="10" style="width: 100px">
        </div>
      </div>
    </div>

    <div id="phoneNumber" style="margin-top: 15px;">
      <label for="addressFormInlinePhoneNumber">PHONE NUMBER<span class="asterisk">*</span></label>
      <div style="margin-top: 6px;">
        <input id="addressFormInlinePhoneNumber" name="addressFormInlinePhoneNumber" type="text" maxlength="32" style="width: 200px;">
      </div>
    </div>

    <div id="email" style="margin-top: 15px;">
      <label for="addressFormInlineEmail" id="addressFormInlineEmailLabel">EMAIL</label>
      <div style="margin-top: 6px;">
        <input id="addressFormInlineEmail" name="addressFormInlineEmail" type="text" maxlength="40" style="width: 200px;">
      </div>
    </div>

    <div id="addressNickname" style="margin-top: 15px;">
      <label for="addressFormInlineAddressNickName">ADDRESS NICKNAME<span class="asterisk">*</span><span class="has-tooltip html-tooltip nickname-tooltip">&nbsp;<span class="tooltip">?</span></span><span class="tooltip">The Address Nickname is a short name you create to help you easily identify this address within your address book.</span></label>
      <div style="margin-top: 6px;">
        <input id="addressFormInlineAddressNickName" name="addressFormInlineAddressNickName" type="text" maxlength="35" placeholder="Holly at school, Mom, etc." style="width: 265px;">
      </div>
    </div>

    <div style="margin-top: 25px;">
      <input name="saveAddressCheckboxInline" id="saveAddressCheckboxInline" type="checkbox" onclick="javascript:AddressForm.enableSetDefaultInline()" checked="checked">
      <label for="saveAddressCheckboxInline">Add to address book. </label>
    </div>

    <div style="margin-top: 6px;">
      <input name="setDefaultCheckboxInline" id="setDefaultCheckboxInline" type="checkbox">
      <label for="setDefaultCheckboxInline" id="setDefaultCheckboxInlineLabel">Save as default shipping address in Address Book</label>
    </div>

    <div id="defaultAddressChangeInline" style="display:none; padding-top:10px !important">
    <!-- BEGIN ContentAreaESpot.jsp -->




<div class="genericESpot" id="WC_ContentAreaESpot_div_1_rx-DefaultAddrConfirm">
  <div class="caption" style="display:none" id="WC_ContentAreaESpot_div_2_rx-DefaultAddrConfirm">[rx-DefaultAddrConfirm]</div>

    <div class="featureAllItems">
      <ul class="featureItemsTable">


          <li value="1">
          <!-- Stores\WebContent\CostcoGLOBALSAS\Snippets\Marketing\ESpot\RenderESpotContent.jspf -->You are changing your Costco Default Shipping Address. &nbsp;All future orders from Costco.com, including Pharmacy Prescription Orders, will be sent to this Address.
          </li>


      </ul>
    </div>

</div>

<!-- END ContentAreaESpot.jsp -->
    </div>

    <div id="button-container" style="margin-top: 25px; height: 51px;">
      <div style="text-align: left; /* margin: 13px 16px */">
        <div style="display: inline-block;">
          <button id="addressFormInlineButton" type="button" class="submit costco-button" style="display: inline" onclick="javascript:AddressForm.interfaces.add(false,submitNewSingleShipping)"><span class="s1"><span class="s2">Ship to this Address</span></span></button>
        </div>
      </div>
    </div>
  </div>
  </form>
